Ultrasound in Obstetrics & Gynecology最新文献

Objective: To develop a prediction model for hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM) in twin pregnancy using characteristics obtained at the first prenatal visit.

Methods: This was a cross-sectional study using national live-birth data in the USA between 2016 and 2021. The association of all prenatal candidate variables with HDP and GDM was tested on univariable and multivariable logistic regression analyses. Prediction models were built with generalized linear models using the logit link function and classification and regression tree (XGboost) machine learning algorithm. Performance was assessed with repeated 2-fold cross-validation and the area under the receiver-operating-characteristics curve (AUC) was calculated. A P value < 0.001 was considered statistically significant.

Results: A total of 707 198 twin pregnancies were included in the HDP analysis and 723 882 twin pregnancies were included in the GDM analysis. The incidence of HDP and GDM increased significantly from 12.6% and 8.1%, respectively, in 2016 to 16.0% and 10.7%, respectively, in 2021. Factors associated with increased odds of HDP in twin pregnancy were maternal age < 20 years or ≥ 35 years, infertility treatment, prepregnancy diabetes mellitus, non-Hispanic Black race, overweight prepregnancy BMI, prepregnancy obesity and Medicaid as the payment source for delivery (P < 0.001 for all). Obesity Class II and III more than doubled the odds of HDP. Factors associated with increased odds of GDM in twin pregnancy were maternal age ≤ 24 years or ≥ 30 years, infertility treatment, prepregnancy hypertension, non-Hispanic Asian race, maternal birthplace outside the USA and prepregnancy obesity (P < 0.001 for all). Maternal age ≥ 30 years, non-Hispanic Asian race and obesity Class I, II and III more than doubled the odds of GDM. For both HDP and GDM, the performances of the machine learning model and logistic regression model were mostly similar, with negligible differences in the performance domains tested. The mean ± SD AUCs of the final machine learning models for HDP and GDM were 0.620 ± 0.001 and 0.671 ± 0.001, respectively.

Conclusions: The incidence of HDP and GDM in twin pregnancies in the USA is increasing. The predictive accuracy of the machine learning models for HDP and GDM in twin pregnancies was similar to that of the logistic regression models. The models for HDP and GDM had modest predictive performance, were well calibrated and did not have poor fit. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Objective: To evaluate the accuracy of fetal biparietal diameter (BPD) measurement in comparison with crown-rump length (CRL) measurement for pregnancy dating at 11-13 weeks' gestation.

Methods: This was a retrospective multicenter cohort study performed in five maternity units in Spain, the UK, Belgium and Bulgaria between January 2011 and December 2019. We included all women who attended a routine ultrasound examination at 11 + 0 to 13 + 6 weeks who had a singleton pregnancy with a viable non-malformed fetus/neonate and ultrasound-derived measurements for both CRL and BPD, along with a comprehensive record of pregnancy outcomes. We developed a formula for pregnancy dating based on BPD using data from pregnancies conceived via in-vitro fertilization (IVF) by applying a simple linear regression. We validated this formula both internally and externally and compared it with the most commonly used formulae (Robinson's CRL-based and Kustermann's BPD-based formulae) through utilization of the Euclidean distance, relative absolute error and mean squared error. We also examined the rate of induction of labor for post-term pregnancy based on dating using each of the formulae.

Results: A total of 49 492 women were included in the study, comprising 47 223 (95.4%) who conceived spontaneously and 2269 (4.6%) who conceived via IVF. In the internal validation performed using data from IVF pregnancies, our newly developed formula showed no significant difference when compared with the true gestational age calculated using conception date, with a mean difference of 0.0006 (95% CI, -0.09 to 0.09) days. In contrast, the mean difference of Kustermann's BPD-based formula was -0.31 (95% CI, -0.46 to -0.17) days and the mean difference of Robinson's CRL-based formula was -1.78 (95% CI, -1.88 to -1.68) days. In the external validation using data from spontaneously conceived pregnancies, with dating using Robinson's formula as the reference for 'true' gestational age, both our formula and Kustermann's formula resulted in underestimation of gestational age, with significant mean differences of -1.25 (95% CI, -1.28 to -1.22) days and -0.96 (95% CI, -0.98 to -0.93) days, respectively. The largest differences compared with Robinson's formula-based dating results were observed between 11 + 0 and 12 + 0 weeks. Dating the pregnancy using Robinson's formula led to 8.1% of pregnancies identified as requiring induction after 41 + 3 weeks, compared with 6.8% (P < 0.001) and 7.0% (P < 0.001) when applying our formula and Kustermann's formula, respectively.

Conclusion: Pregnancy dating based on ultrasound measurement of fetal BPD between 11 + 0 and 13 + 6 weeks' gestation is a reliable alternative to dating based on fetal CRL. © 2025 International Society of Ultrasound in Obstetrics and Gynecology.